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General NPI Number Information
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NPI Number | 1649973116
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Entity Type | Individual
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Provider Name | MATTHEW SHERIDAN
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Gender | Male
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 12443 SAN JOSE BLVD STE 604
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City | JACKSONVILLE
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State | FL
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Zip | 32223-8652
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Country | US
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Telephone | 904-944-4625
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 HERSCHEL ST APT A
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3879
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH21863
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License Number State | FL
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